Individual provider Active NPI

Sally T Coates, LCSW

  • Clinical Social Worker
  • Lubbock, TX
National Provider Identifier
1770538829
Registry record updated Dec 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
24340 Issued in TX
Practice address
301 40TH St
Lubbock, TX 79404
Phone
(806) 743-9355
Fax
(806) 743-9363
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 24340 TX Primary

Addresses

Primary practice location

301 40TH St
Lubbock, TX 79404

Mailing address

301 40TH St
Lubbock, TX 79404-2746
Phone (806) 743-9355

Other identifiers 1

IdentifierTypeStateIssuer
168786501MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Senior.House@direct.myteamcare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040511000846 TX Practitioner - Clinical Social Worker 1254320518 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

301 40TH St
Lubbock, TX 79404-2746
Phone (806) 743-9355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
24340TXMDCommunity/Retail Pharmacy

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center - Son - Lubbock Clinical CurrentSince Sep 8, 2003 Accepting new patients
Texas Tech University Health Sciences Center - Son - Lubbock CurrentSince Sep 8, 2003 Accepting new patients

Locations

301 40th St
Lubbock, TX 79404
Phone (806) 743-9355

Interoperability endpoints

  • Direct secure messaging: sally.coates@direct.myteamcare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576281600000",
    "number": "1770538829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 40TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794042746",
            "telephone_number": "806-743-9355",
            "fax_number": "806-743-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 40TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79404",
            "telephone_number": "806-743-9355",
            "fax_number": "806-743-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COATES",
        "first_name": "SALLY",
        "middle_name": "T",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2019-12-14",
        "certification_date": "2019-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "24340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168786501",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Senior.House@direct.myteamcare.com",
            "affiliation": "N",
            "endpointDescription": "SHC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "301 40th St",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "79404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.